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PubMed1998

Urinary symptoms, potency, and quality of life in patients with localized prostate cancer followed up with deferred treatment.

OBJECTIVES: To evaluate urinary symptoms, potency, and quality of life in a group of patients with prostate cancer followed up with deferred treatment. METHODS: A self-administered questionnaire was mailed to patients with localized prostate cancer who were followed up with deferred treatment. Data regarding clinical stage, pathologic grade, and treatment after diagnosis were obtained from patient files. RESULTS: A total of 71 consecutive patients (age 79 years or less) were included. Of the 52 patients (73%) who responded, 31% had undergone transurethral resection of the prostate, 8% underwent radiation therapy, and 44% underwent hormonal deprivation during the follow-up period. With respect to incontinence, 21% were using pads and 37% leaked urine daily; in 21% of the patients, urine dripping or leaking was a substantial problem. Before the diagnosis of their prostate cancer, 81% stated they were able to have an erection. At the time of the questionnaire, 77% stated that their ability to have erections was reduced and only 29% had had an erection after the prostate cancer was diagnosed. For 12%, impotence was a problem. With respect to quality of life, 52% of the patients rated their health as excellent or good and 61% would be happy to spend the rest of their life feeling the way they did at the time of the questionnaire. Eighty-five percent were satisfied with the treatment policy for their prostate cancer, and 96% would choose deferred treatment again if faced with the decision. CONCLUSIONS: By use of a self-administered questionnaire, a high frequency of incontinence and impotence was found in a group of patients with prostate cancer followed up with deferred treatment. Despite these problems, more than half of the patients rated their health as good and would undergo expectant management again if faced with the decision.

Aged↗
PubMed2002

Subjective and objective incontinence 5 to 10 years after Burch colposuspension.

The outcome of incontinence surgery was studied using a questionnaire, a 24-hour pad test (24hPT), and a stress test (ST). Five to 10 years after a Burch colposuspension, 111 patients were asked to complete the Bristol Female Urinary Tract Symptom Questionnaire (BFLUTS) and to perform a 24hPT and a ST. Eighty-two patients completed the questionnaire and 71 and 69 patients performed the stress and pad tests, respectively. Seventy-three percent of the patients did not leak during the ST and 75% of the patients were not leaking during the 24hPT. Seventy-three percent of the patients stated that they were at least occasionally stress or urge incontinent and 62% stated that they were both stress and urge incontinent. However, only 24% of the stress incontinent and 28% of the urge incontinent patients found their incontinence to be "quite a problem" or "a serious problem." Patients leaking urine only "occasionally," "once a week," leaking "drops," and finding the leakage to be "a bit of a problem" had median leakage 0g during ST and 24hPT. Patients who reported the leakage to occur "sometimes" "most or all of the time" and who found the leakage to be "a bit, quite, or a serious problem" accounted for 20 to 30% of all patients, as did patients leaking during objective tests. Objective tests revealed leakage to occur less frequently compared with self-reported leakage. The BFLUTS questionnaire revealed leakage to occur with varying frequency, amount, and bother. Leakage occurring seldom, of small amount and bother may be of minor clinical importance.

Adult↗
PubMedDate not supplied

[Fecal incontinence in the elderly].

UNLABELLED: Fecal incontinence (FI) is a devastating condition that affects quality of life. Age and gender are related with the prevalence of FI. In adults, prevalence varies from 2% to 7%. It is more frequent in women than in men (3:1) and is more prevalent in elderly patients. There are no studies in Mexico that evaluate the frequency of FI in adults older than 60 years. AIM: To investigate the FI frequency, severity and associated factors in patients > or = 60 years. PATIENTS AND METHODS: Three groups of patients were included: a) Group I: consecutive outpatients patients from the Gastroenterology and Geriatrics Clinics of the INCMNSZ; b) Group II: INCMNSZ inpatients admitted due to a non-related condition with FI; c) Group III: Reyna Sofia nursing home residents (NHR) in Mexico City. A structured questionnaire was used to obtain demographic data, comorbidity and associated factors with FI. Grade of FI was assessed with the Wexner scale. RESULTS: 159 patients were included, 89 (56%) were women. Mean age was 75 years (range 59-98). There were 54 patients in group I, 50 in group II and 55 in group III. Overall frequency of FI was 33% (n = 53). Frequency of FI was 26% in group 1, 20% in group II and 53% in group III. Sixty six percent (n = 35) of the FI cases were female. Neuropsychiatric disorders were associated to FI in 29 patients (54%) and diabetes mellitus in 17 (32%). Eighty percent of patients wore disposable pads for FI. Urinary incontinence was associated to FI in 31 (58%). Thirteen (24%) patients had mild FI, 20 (38%) moderate, and 20 (38%) severe FI. The severity score for FI was lower in groups I and II (8.1 y 9.7) than in group III (18, p = 0.001). Age in patients with mild FI was significantly lower (73 years) than in patients with severe FI (83y, p = 0.01). CONCLUSIONS: FI in patients older than 60 years old is a very common condition. FI was more frequent and severe in women, in NHR and in those with neuropsychiatric disorders. Urinary incontinence was associated in half of patients with FI.

Age Factors↗
PubMed1995

Incontinence and vesical neck strictures following radical retropubic prostatectomy.

OBJECTIVES: To evaluate the incidence and severity of vesical neck strictures and urinary incontinence after radical retropubic prostatectomy (RRP) for prostate cancer. METHODS: Between August 1983 and December 1991, 481 consecutive patients underwent RRP by 1 of 2 senior surgeons. Strictures were treated by passing a urethral sound. Incontinence was measured by asking patients for a daily "pad count" of pads required to control urinary leakage. Results were compared to patient age, tumor volume, number of neurovascular bundles spared, preoperative urinary complaints, and previous transurethral resection of the prostate. RESULTS: Of 456 patients with adequate follow-up to determine stricture formation, 82.5% had no strictures, 6.8% required a single dilation, 3.7% required 2 dilations, 3.1% required 3 dilations, and 3.9% required more than 3 dilations. Risk of stricture formation was unrelated to every variable studied. Of 458 patients with adequate follow-up to determine recovery of continence, 80.1% required no pads, 8.1% required 1 to 2 pads a day, 6.6% required 3 to 5 pads a day, and 5.2% were totally incontinent 1 year or more after surgery. Incontinence was closely associated with postoperative urinary urgency. CONCLUSIONS: Strictures are a common but easily managed complication of RRP for prostate cancer. Despite substantial surgical experience, we report a somewhat higher rate of postoperative incontinence than other recently reported series. Our experience is more closely matched by published surveys of patient-reported complications after RRP.

Aged↗
PubMed2000

[Clinical evaluation of female urinary incontinence].

EXAMINATION: Clinical evaluation of stress and urge incontinence is always necessary before therapeutic decisions. Full bladder examination may reveal stress incontinence during cough when cervico-urethral hypermobility is suspected, and leak during Vasalva manoeuvre when incontinence is due to intrinsic sphincter deficiency. OBJECTIVE SCORES: Pad test objectives the quantitative importance of incontinence. Symptom scores allow intra and inter individual comparisons. Psychosocial implications are studied with specific quality of life scales. They allow better therapeutic strategies in the management of urge and stress urinary incontinence. Objective evaluation of the different treatments and medico-economic approach of incontinence are thus possible.

Diagnosis, Differential↗
PubMed2007

Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction.

AIMS: A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. METHODS: After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t-test, with Sigma Stat(R). RESULTS: Seventy-six patients (79%) were available with a mean follow-up time of 30.7 +/- 1.7 months and mean age of 69.3 +/- 11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n = 36), average pad use per day decreased significantly from 2.1 +/- 0.4 to 0.8 +/- 0.2 (P < 0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9 +/- 0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). CONCLUSIONS: Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable.

Aged↗
PubMed1998

Minimally invasive pervaginam procedures for the treatment of female stress incontinence using a new pubic bone anchoring system.

The purpose of this ongoing study is to evaluate the safety and efficacy of new minimally invasive pervaginam cystourethropexy and sling procedures for the treatment of female genuine stress urinary incontinence. A total of 75 women (mean age, 52.8 years) underwent either a cystourethropexy or a sling procedure. A miniature bone anchor and a staple-like bone anchor driver were used for the fixation of periurethral tissue or a xenogenic sling to the pubic bone. With a mean follow-up of eight months, 61 patients (82%) were completely cured of stress incontinence, 10 (14%) reported a more than 50% decrease in pad usage, and 4 patients showed failure early following surgery. The exclusively pervaginam cystourethropexy and sling procedures are minimally invasive, safe, and effective. Further experience and longer follow-up are necessary to establish their role in the treatment of women with stress urinary incontinence.

Adult↗
PubMed1995

Ileal pouch-anal anastomosis function following childbirth. An extended evaluation.

PURPOSE: Women undergoing ileal pouch-anal anastomosis (IPAA) are frequently within reproductive years and eager to bear children. Management issues have been raised regarding the effects of pregnancy and delivery on the pouch, particularly with respect to obstetric care. Our experience is updated to search for delayed sequelae of pregnancy and delivery and to establish whether other factors have an adverse effect on pouch function. These results are also compared with the outcome of pregnancy and delivery in patients with ileostomy or Kock pouch. METHODS: Records of 43 women who had a successful pregnancy and delivery following IPAA were reviewed, including 8 women who had more than 1 pregnancy. RESULTS: Pregnancy was generally well tolerated, with complications being managed nonoperatively. Stool frequency (P < 0.01), incontinence (P < 0.01), and pad usage (P < 0.05; sign rank test) were significantly increased during pregnancy, but prepregnancy function was restored following delivery. Vaginal delivery, multiple births, length of labor, and birth weight had no adverse permanent effect on subsequent pouch function. Longer follow-up after vaginal delivery (mean, 2.4 years) demonstrated no compromise of pouch function. CONCLUSIONS: Incidence of pouch-related complications in patients with IPAA compares favorably with incidence in patients with ileostomy or Kock pouch. Operative rate for complications was 0 percent in IPAA patients compared with 9 percent in patients with ileostomy and 19 percent in patients with Kock pouch. The cesarean section rate was higher in patients with IPAA than in those with ileostomy or Kock pouch, and this may be caused by uncertainty about how to manage delivery in patients with IPAA. Pregnancy and childbirth are well tolerated in women with IPAA, with a lower complication rate and a higher cesarean section rate than women with ileostomy or Kock pouch. Type of delivery should be influenced by obstetric considerations, with vaginal delivery avoided in patients with a noncompliant, rigid perineum.

Adult↗
PubMed1996

Treatment of urinary incontinence in women in general practice: observational study.

OBJECTIVE: To examine what is attainable when treating urinary incontinence in women in general practice. DESIGN: Observational study with 12 months' follow up. Interview and clinical examination before, during, and after treatment of women seeking help for urinary incontinence in general practice. SETTING: General practice in the rural district of Rissa, Norway. SUBJECTS: 105 women aged 20 or more with urinary incontinence. INTERVENTIONS: Treatment with pelvic floor exercises, electrostimulation, oestrogen, anticholinergic drugs, bladder training, and protective pads. MAIN OUTCOME MEASURES: Subjective and objective measures of urinary incontinence; number of patients referred to a specialist. RESULTS: After 12 months' follow up 70% (69/99) of the women were cured or much better; the mean score on a 100 mm visual analogue scale decreased from 37 to 20 mm; and the proportion of women who were greatly bothered by their incontinence decreased by 62%. 20% (20/98) of women became continent, and the percentage of women with severe incontinence decreased from 64% (63/99) to 28% (27/98). Mean leakage per 24 hours measured by a pad test decreased from 28 g at the start of treatment to 13 g after 12 months. The number of light weight pads or sanitary towels decreased from 1.6 to 0.6 a day. In all, 17/105 (16%) patients were referred to a specialist. CONCLUSIONS: Urinary incontinence in women can be effectively managed in general practice with fairly simple treatment. Most women will be satisfied with the results.

Adult↗
PubMed2002

Questionnaire-based outcomes of urinary incontinence and satisfaction rates after radical prostatectomy in a national study population.

OBJECTIVES: To assess the incidence of incontinence and the associated quality of life in men younger than 65 years of age after radical prostatectomy. METHODS: The TRICARE/CHAMPUS database was searched to identify 1000 patients who underwent radical prostatectomy within 2 years before study initiation. All patients were younger than 65 years of age at the time of surgery and had at least 18 months of postoperative follow-up. An eight-part questionnaire focusing on continence after surgery was mailed to the study population. Respondents reported on voiding dysfunction, degree of incontinence, satisfaction with continence, and lifestyle impact of incontinence. RESULTS: A total of 674 eligible patients (78%) completed the survey. Any amount of pad use or changing of underwear to keep dry was reported by 31.7%, leakage once per day occurred in 16.8%, and leakage more than once per day in 9.2%. Severe urgency or urge incontinence occurred in 17.4% and was the primary cause of incontinence in one third of patients with incontinence. Only 8.9% of patients used two or more pads per day, and severe incontinence (more than four pads per day) occurred in 2.7%. Incontinence-corrective surgery was used by 4.9% of patients. Overall, 83.3% of patients reported satisfaction with their continence after surgery, and 12% considered postoperative incontinence to be a problem. CONCLUSIONS: The results of this questionnaire-based outcomes evaluation of a large national sample of prostatectomy patients younger than 65 years of age demonstrate that incontinence rates in this younger population are similar to those in the Medicare population and may be more representative of the national experience than single-center reports.

Humans↗
PubMed2005

The male perineal sling: intermediate-term results.

AIMS: In men with stress urinary incontinence (SUI) due to sphincteric incompetence, surgical options include periurethral injection of bulking agents, implantation of an artificial urinary sphincter (AUS), and sling surgery. Short-term results of the male sling have generally been favorable. We report the intermediate-term results of the bone-anchored male perineal sling with a median of 4 years and minimum of 2 years follow-up. METHODS: From March 2000 to April 2003, 48 patients (average age = 68 years) underwent male sling surgery. Patients were evaluated pre-operatively and post-operatively via history, physical examination, pad score, and administration of the incontinence section of the UCLA/RAND prostate cancer index (PCI). RESULTS: Pre-operatively all patients rated their incontinence as severe, and used >or=3 pads daily. Median follow-up was 48 months (range = 24-60). Average pad usage decreased from 4.6 +/- 2.1 pads per day to 1.0 +/- 1.7 pads per day (P < 0.01). Median UCLA PCI incontinence score increased from 63-343 (P < 0.01). Overall, 31/48 patient (65%) were cured of their leakage (no problem, no pads), 7/48 (15%) were much improved (small problem, 1 pad), 3/48 (6%) were mildly improved (moderate problem, 2 pads daily), and 7/48 (15%) failed (big problem, >or=3 pads). CONCLUSIONS: Intermediate-term results for the male sling demonstrate a success rate comparable to that of the AUS (80% <or= 1 pad daily). This technique has established a very low morbidity, and is a reliable alternative to AUS surgery for the treatment of male SUI.

Aged↗
PubMed2002

Prospective, randomized trial comparing sigmoid vs. descending colonic J-pouch after total rectal excision.

PURPOSE: The aim of this study was to compare the bowel function of sigmoid vs. descending colonic J-pouches after ultralow anterior resection for rectal cancer. METHODS: A prospective, randomized trial was conducted from March 1998 to September 1999. Ninety-two consecutive patients undergoing ultralow anterior resection for cancers arising from 3 to 10 cm from the anal verge were recruited. Forty-eight patients were males; the mean ages (standard error of the mean) for patients with sigmoid and descending colon pouches, respectively, were 65.2 (3.1) years and 62.3 (3.1) years. A total of 46 patients were randomly assigned to each group. Two patients from each group were excluded; abdominoperineal resection was performed for two patients in the sigmoid pouch group and one patient in the descending pouch group. One patient in the descending pouch group had a transanal resection of a benign polyp. Dukes staging and use of postoperative chemoradiotherapy were statistically similar in both groups. All patients underwent a standardized ultralow anterior resection. A defunctioning loop ileostomy was used routinely. Anorectal physiology and bowel function questionnaires were performed at six weeks after ileostomy closure and again at 6 and 12 months after surgery. RESULTS: Median follow-up was 12 (range, 7 to 25) and 12 (range, 6 to 25) months, respectively, for sigmoid and descending pouch groups. Median tumor and anastomotic heights, time to ileostomy closure, operative time, and postoperative stay were statistically similar in both groups. There were no significant differences in stool frequency, incontinence, urgency, use of pads and antidiarrheals, sensation of incomplete evacuation, and anorectal physiology results between groups (P > 0.05). CONCLUSION: Pouches made from sigmoid or descending colon give similar bowel function after ultralow anterior resection for rectal cancers.

Adenocarcinoma↗
PubMed1991

Radiotherapy following radical prostatectomy in patients with adenocarcinoma of the prostate.

From 1973 to 1986, 160 patients with adenocarcinoma localized to the prostate were treated with radical prostatectomy and pelvic lymphadenectomy. In 78 (49%) patients more advanced stage of disease was found at surgery and they received local pelvic irradiation (RT). This consisted of 45 Gy for microscopic and 55 Gy for macroscopic residual disease. RT was given at 1.8 Gy a day, using the four-field "box" technique with the 23 MV X ray beam. Pelvic lymph node metastases were found in 28 (36%) patients who, in addition to RT, received systemic therapy: 20 with cyclophosphamide alone, 4 combined with 5-Fluorouracil, and 4 patients received DES. The 5- and 10-year overall actuarial survival was 95 and 77%, respectively, and the 5- and 10-year disease-free survival was 58 and 43%, respectively. Recurrent tumor was found in 34 (44%) patients. Of these 34 patients, 32 (94%) had distant metastatic tumor and 2 (6%) had local recurrence in the pelvis. The presence of metastatic disease in pelvic lymph nodes had clinical significance since it influenced disease-free survival and the incidence of tumor recurrence. The 10-year disease-free survival for the 50 patients with no lymph node metastases was 51%, as compared to 28% for the 28 patients with such metastases, p = 0.001. Similarly, recurrent tumor was found in 28% of the former and 68% of the latter patients, p = 0.002. Other important parameters predicting recurrence were: clinical stage, p = 0.018, histological grade, p = 0.013, and Gleason's grade, p = 0.002. This treatment program was very well tolerated and of low toxicity. There was no surgical mortality. Surgical complications were seen in 10 (13%) patients including: minor in 5 and major in 5. At 1 year, 77% of the patients remained continent, while 10% had mild stress incontinence. Of the remaining 13% only 3 (4%) patients had severe incontinence (greater than 5 pads daily). RT toxicity was mild with 38% experiencing diarrhea. Severe toxicity was seen in 2 (3%) patients who, early in the study, developed scrotal and lower extremity edema. Severe chemotherapy complications were seen in 1 (4%) patient who had severe neutropenic sepsis. Postoperative radiotherapy is a well tolerated, safe and effective treatment in patients who have microscopic or macroscopic residual tumor following radical prostatectomy.

Adenocarcinoma↗
PubMed2005

Laparoscopic extraperitoneal radical prostatectomy--learning curve of a laparoscopy-naive urologist in a community hospital.

OBJECTIVES: To describe the training approach that a laparoscopy-naive general urologist working in a nonteaching hospital used to successfully learn to perform laparoscopic extraperitoneal radical prostatectomy and describe the results obtained in the first 114 cases performed. METHODS: The urologist assisted an experienced laparoscopic surgeon for 20 extraperitoneal radical prostatectomies. During this time, he modified his technique of performing open radical retropubic prostatectomy to facilitate the acquisition of the laparoscopic techniques. Intracorporeal suturing was learned with the aid of a pelvic trainer. The clinical records of the first consecutive 114 cases were examined to evaluate the outcomes in terms of morbidity and oncological and functional concerns. A similar analysis was performed on a subgroup of 15 patients who had undergone laparoscopic extraperitoneal radical prostatectomy after previous transurethral resection of the prostate. RESULTS: The operating time progressively decreased during the learning curve. The mean duration of surgery was 160 minutes. Two conversions to open surgery were required owing to failure to progress. Of the 114 patients, 14% experienced complications, most of which were minor. The positive surgical margin rate was 17%. The average follow-up was 16 months. Undetectable serum prostate-specific antigen levels were observed in 82%, 87%, and 79% at 6, 12, and 18 months, respectively; 96% of patients used 0 to 1 pad per day for incontinence at 6 months of follow-up. The results in the transurethral resection subgroup were similar. CONCLUSIONS: Laparoscopic extraperitoneal radical prostatectomy can be successfully learned by a general urologist with no prior laparoscopic experience.

Adult↗
PubMed1994

Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer.

To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

A long-term follow-up of autoaugmentation in myelodysplastic children.

OBJECTIVE: To evaluate the long-term results of patients who underwent bladder autoaugmentation (BA) in whom BA was used to treat a neuropathic bladder secondary to myelomeningocele, and who presented with a high-pressure/poorly compliant bladder. PATIENTS AND METHODS: Eleven patients (eight girls and three boys, mean age 12.8 years, mean follow-up 6.6 years) were selected who had undergone BA between June 1991 and June 1994. At surgery, the patients had a poorly compliant bladder with a mean leak point volume (LPV) of 94 mL and a mean leak point pressure (LPP) of 58 cmH2O. None of the patients had vesico-ureteric reflux (VUR) at BA; five with grade III or IV VUR had undergone endoscopic correction in a day-surgery procedure using a suburethral collagen injection 1-3 weeks before BA. The patients were evaluated using clinical, urodynamic, radiological and endoscopic assessments. The LPV, LPP and safe bladder capacity (SBC, the cystometric volume at an intravesical pressure of 40 cmH2O) were recorded. RESULTS: At 1 year after surgery the mean LPV was 297 mL; none of the patients had VUR. The most recent mean LPV was 198 mL and the SBC 167 mL. The mean LPP remained stable at 60 cmH2O. At the last follow-up four patients had recurrent uni- or bilateral grade III-V VUR. At endoscopy the 'augmented' bladder portion had a smooth surface, compared with the grossly trabeculated lower half. From this finding all patients on clean intermittent catheterization were treated with oral oxybutynin. Some patients reported slightly less abdominal pain at maximum bladder volume; four needed pads to treat intermittent incontinence. On voiding cysto-urethrography, one patient had an hourglass-shaped bladder. Five patients recently underwent ileocystoplasty because of recurrent urinary tract infection, high-grade VUR and incontinence. CONCLUSION: These results do not justify the routine use of BA in hypertonic/poorly compliant bladders secondary to myelomeningocele. The mean follow-up of 6.6 years showed that this procedure failed in seven of 11 patients. Further studies might be able to identify subgroups in which this approach may be more appropriate.

Child↗
PubMed2001

A Norwegian national cohort of 3198 women treated with home-managed electrical stimulation for urinary incontinence--effectiveness and treatment results.

OBJECTIVE: The aim of this study was to analyse the effectiveness of home-managed electrical stimulation. MATERIAL AND METHODS: A prospective cohort study was conducted on all 3198 women treated with home-managed electrical stimulation in Norway during 1992-1994. Data were collected from both patients and physicians by questionnaires before and after treatment. RESULTS: 29% of the women were cured or much improved according to their own assessment; altogether 61% were improved. According to the physicians' assessment, 33% were cured or much improved; a total of 55% was improved. Thirty-seven per cent of compliers and 12% of non-compliers regarded themselves as cured or much improved. The number of incontinence episodes, amount of leakage and use of pads decreased significantly; and 44% had less severe incontinence than before treatment according to a validated severity index. CONCLUSIONS: Women treated with electrical stimulation for urinary incontinence experienced a significant reduction in incontinence problems, both subjectively and semi-objectively. The treatment results seem to be strongly dependent on good acceptance of the treatment.

Adult↗
PubMed1989

Three years' experience with an ileal low pressure bladder substitute.

At the beginning of this century it was realised that peristalsis would cause incontinence if bowel was used for augmentation or substitution of the bladder. Trans-section of the antimesenteric border and cross-folding of the intestinal segments (Goodwin's cup-patch technique) is an efficient means of solving this problem and has been successfully used in the Kock pouch. We anastomosed the ileal low pressure reservoir to the membranous urethra in 22 male patients following radical cystoprostatectomy for bladder cancer. The mean observation time was 16 months (range 3-36). The capacity of the bladder substitute increased with time, the average being 450 ml after 6 months. In the first 4 patients with a short (2-5 cm) intestinal segment between the pouch and the urethra, micturition was prolonged, residual urine varied from 50 to 300 ml and bacteriuria was found. Occasional expulsions of several ml of urine were caused by peristalsis within this short tubular segment. In the following 18 patients, the low pressure reservoir was anastomosed directly to the membranous urethra. Micturition was good, with no notable residual urine, no bacteriuria and no paroxysmal urinary incontinence. However, a safety pad is used by half of the patients because once or twice a week, mainly at night, a few ml of urine may be lost. No significant changes in serum electrolytes, bicarbonate or creatinine were noted. With the three different antireflux techniques used, no obstructive or inflammatory changes in the upper urinary tracts were found, although no long-term antibiotic prophylaxis was given.

Aged↗